The uses of cardiovascular risk estimationStrokes, heart attacks and peripheral arterial disease - cardiovascular risk is about common and important ill health outcomes.Any moves you make to reduce this risk, will have lots of more immediate benefits, however. Common recommendations to wait until after 45 years age before assessing this risk, are made because the authorities assume pharmaceuticals will be prescribed when the chance of benefit is small. Earlier assessment will allow one more years of healthier lifestyle and correction of metabolic disturbances by natural means. If you are seeking advice on your personal cvs risk, it is worth understanding about relative and absolute risk reduction. If you have a very small risk of something happening, even a 50% (relative) reduction in that risk is not very important. The absolute risk reduction will also be very small. Conversely if one's risk is high, everything matters12. The National Heart Foundation of New Zealand has published an absolute risk calculator which is quick and easy to use... The chart uses total chloesterol / HDL ratio, as this is a much better predictor of coronary artery disease risk than is the total cholesterol alone. Always make sure that a HDL is done whenever your cholesterol is measured.
The NNT is 16. Total expected events untreated are 3, so the figures are as seen. Another person might say that taking drugs for 5 years, with the risks and doctor visits entailed, all for one chance of benefit in 16, would not interest them. I do point out as I present the figures, that the two episodes of illness may not have been as severe, and that the other 13 people may have not developed arterial disease as much, reducing future risk. The benefits of various medications are commonly quoted as percentage relative risk reductions. These don't mean much without the above type of information. Homocysteine should be included in cardiovascular risk testsThis substance is a partial breakdown product of methionine, one of the building blocks of our proteins.The breakdown cannot be completed nor reversed, because of lack of one of four substances needed for these jobs. The four factors are vitamins B6, 9 and 12 and betaine. Homocysteine has the same history in medicine as cholesterol. Families were found who had very high levels due to genetic mutations, and very increased cardiovascular risk. Increased homocysteine levels are associated with 10% of the variance in risk between middle aged males. Cholesterol accounts for a smaller proportion Correcting the appropriate deficiency often relieves symptoms such as fatigue, balance problems and sleep disturbance. It is definitely not a case of pie in the sky... The most recent Cochrane review on this subject, concluded that there is no evidence that reducing homocysteine with vitamins, will reduce CVS risk. They state however..."It is interesting to mention that HOPE-2 2006 study (which showed a significant reduction of stroke) was the only study to use an adequate dose of vitamin B12." It appears that none of the studies included, looked at whether people had Helicobactor pylori infection, which causes vit B12 and folate deficiency. Certainly none of them used injections of vitamin B12. I think the jury should still be out.
Full versions of cardiovascular risk calculatorsThis first one uses imperial units, as in USACoronary Heart Disease Framingham Point Scores
This one uses SI units as in Australia Full copy of New Zealand risk calculator
The MacArthur Successful Aging Study, a longitudinal study of high-functioning men and women, average age 74, was recently reported (in the October '09 issue of the Annals of Epidemiology.)Waist-hip ratio was found to predict all-cause mortality in these older adults. Whether over eating and under exercising are purely habits or due to our belief systems or emotional stuff, this whole scenario often offers the greatest possibilities for useful change in our lives. You can feel better as well as living longer, which is really more to the point. If you're in the mood for radical change, look at Leslie Kenton's book
"The New Raw Energy." Cigarettes and heart diseaseThe original evidence in favour of this connection, was actually quite weak.Evidence is now coming up after introduction of anti smoking legislation, which may be still just an association rather than cause and effect. Never-the-less, where there's smoke there's fire. I'll keep an open mind on it, and advise people to stop smoking. Glycosylated haemoglobin ( HbA1c ) is an independant risk factorSugar sticks to protein, at a rate dependent on the sugar level in the blood. This is measured in our haemoglobin, to monitor blood sugar levels in diabetes.It is one of the factors which accelerate aging, and has just been shown6 to predict cardiovascular disease and all cause mortality in people without diabetes. The best HbA1c was 5-5.4, with progressively more trouble as levels rose, but also higher mortality if <5%. This is an example of the "J-shaped curve" often seen, where too much or too little of something indicates trouble.
Revised recommendations for diabetes diagnosis - hemoglobin A1c (HbA1c) is an easier diagnostic test, not requiring the 12 hours water only and two hours waiting needed for the OGGT used now.The new recommendations are published December 29 in the January supplement of Diabetes Care. They believe that use of the HbA1c will encourage more people to get tested for type 2 diabetes and help further reduce the number of people who are unaware of this cardiovascular risk factor. Type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range." Peridontal gum disease and cardiovascular riskA really hot topic in cardiology research is the "vulnerable plaque." Thin-cap fibroatheroma is thought to be more at risk of rupture and subsequent blood clot blocking the artery.Intravascular ultrasound is being used to find ruptured plaques in people with unstable angina. Why do plaques rupture or get surface erosion? This is one possible connection with peridontal disease, which is a known potent risk factor for heart attacks. Gum disease can increase a general tendency to inflammation throughout our body, and can lead to dissemination of germs via our blood stream. These can then damage plaques. Treating gum disease to protect your heart
And the combination of ischaemic heart disease with depression is associated with abnormal platelet activation as measured by platelet factor 4 and beta thromboglobulin tests.Both conditions need good treatment now.
Over age 55, ED (not a talking horse) carries 11% 5-year CVS risk, but it carries some extra risk even in one's 30's.In men with type 11 diabetes, it is the strongest CVS risk factor. This can be because of otherwise subclinical arterial disease of the penile arteries, but is often caused by the same vascular endothelial dysfunction which contributes to artery disease in general.
N-terminal pro-brain natriuretic peptide is a mouthful, but was better than CRP at predicting major CVS events in older men11.
The spasm of resistance vessels may directly induce symptoms in ischemic diseases.This is a credible theory1, and opens possibilities for treatment aimed at reducing the risk of spasm, such as magnesium supplements. Vagal withdrawal & Sympathetic activation, causing arrhythmiasReduced baroreflex sensitivity after heart attacks, and low heart rate variability, both indicating vagal underactivity, have been shown to be associated with substantially increased risk of subsequent sudden death.After recovery from ventricular fibrillation, people have markedly increased cardiac sympathetic activity. This dysfunction of the autonomic nerve control of the heart increases with age. Omega-3 oil supplements reduced heart rate and increased heart rate variability in depressed patients with coronary heart disease, in one study7. Microembolism of vasa vasorum of coronary arteriesThe tiny blood vessels which supply nutrition to the walls of the coronary arteries themselves, have been shown to get blocked.This may be important in the development of plaque instability, or even the development of plaque in the first place. See3 http://www.thincs.org and http://www.ravnskov.nu/cholesterol.htm A2 milk - the way it used to be ( may have been better)A strong relationship has been found2 between the amount of A1 β-casein consumed and heart disease mortality.Apparently cows used to produce A2 beta casein, and still do in some areas of the world. The difference is only one amino acid, but it changes the way our body uses the milk. This genetic variant may have come from intensive dairy cattle breeding. A2 milk - another way to reduce your cardiovascular risk. Chronic kidney disease is a cardiovascular risk factorA morning urine albumen/creatinine ratio test is a very early sign of renal damage and a useful CVS risk factor.In terms of mortality risk, urinary albumin excretion is a better risk stratifier than traditional risk factors, such as cholesterol9. A new test for chronic renal insufficiency, called cystatin C, is very useful in young to middle aged people, for cardiovascular risk stratification. Can infection cause heart disease?Chlamydia pneumoniae has been found in the fatty plaques from coronary arteries, and may help cause surface damage and instability.A very good discussion of this, from 2000, is at http://qjmed.oxfordjournals.org/cgi/content/full/93/6/375 KIF6 polymorphism and risk of coronary events."kinesin-like protein family member 6" is one result of "a flurry of studies" linking tiny DNA variations called single nucleotide polymorphisms (SNPs) with risk of various diseases.A KIF6 variation with one amino acid altered, present in nearly 60% of the population, is associated with about 50% more heart disease or strokes. It also tells who will respond to statin drugs8, and the benefits aren't related to how much a statin lowers cholesterol. If you are considering taking an expensive drug with an unknown long term safety, it would be very nice to know ahead of time if it had much chance of helping you. Statin drugs have overall very little chance of helping you if your absolute risk is low10.
Large artery stiffening and central (aortic) systolic blood pressure.Greater pulse pressure is an independent risk factor for cardiovascular disease.Pulse pressure depends on how fast the heart ejects blood, how much blood it ejects and the elasticity of the major arteries receiving the blood. The value from ordinary blood pressure measurement, is less than in the aorta, in people with stiff arteries (when it matters.) This is because the stiff arteries dampen the pulse wave by the time it gets to the arm. Our brain and kidneys are not so lucky, as they are closer to the heart and have high blood flow. The pulsatile flow reaches and damages small blood vessels here. The heart suffers as well, because the pressure wave bounces back to it too soon, while it is still ejecting blood, instead of after contraction (when it helps coronary artery blood flow.) Measurement of arterial stiffness from pulse wave velocity or from analysis of the wrist pulse wave, is not yet mainstream medicine. It is a case of "watch this space" but even just on spec, nutritional support of elastin synthesis by arterial smooth muscle cells, is worth considering as part of cardiovascular risk reduction.
1. Med Hypotheses. 1999 Sept 53(3):200-209.2. Ischaemic heart disease, Type 1 diabetes, and cow milk A1 beta casein. 3. "Vulnerable Plaque Formation from Obstruction of Vasa Vasorum by Homocysteinylated and Oxidized Lipoprotein Aggregates Complexed with Microbial Remnants and LDL Autoantibodies" Several studies have suggested that the FRS overestimates the cardiovascular risk in Japanese-American and Hispanic men, in Native American women, and in European and Asian populations. It uses age, sex, total cholesterol, total cholesterol to HDL-C ratio, systolic blood pressure, and cigarette smoking. It has separate risk scores for higher risk and lower risk regions of Europe. A nonlaboratory-based model5 using the same risk factors from the FRS but excluding HDL, and total cholesterol and adding body mass index, gave almost identical ability to accurately discriminate CVD. In my opinion this just shows the weakness of the relationship between cholesterol and heart disease. 4. Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project Eur Heart J 2003;24:987–1003. 5. Gaziano TA et al. Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I follow-up study cohort Lancet 2008;371:923–31. 6. Selvin E et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med 2010; 362:800-811. (Analysis from the Atherosclerosis Risk in Communities (ARIC) study, after median follow up of about 14 years.) 7. Carney RM et al Effect of Omega-3 Fatty Acids on Heart Rate Variability in Depressed Patients With Coronary Heart Disease. Psychosom Med. 2010 Aug 17. 8. Li Y et al KIF6 Polymorphism as a Predictor of Risk of Coronary Events and of Clinical Event Reduction by Statin Therapy. Am J Cardiol. 2010 Oct 1;106(7):994-8 9. Matsushita K et al Chronic Kidney Disease Prognosis Consortium; Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375:2073-2081. 10 Fiona Taylor et al Statins for the primary prevention of cardiovascular disease Cochrane Heart Group. Issue 1, 2011. 11. S. Goya Wannamethee et al Journal of the American College of Cardiology 58(1) June 2011 N-Terminal Pro-Brain Natriuretic Peptide Is a More Useful Predictor of Cardiovascular Disease Risk Than C-Reactive Protein in Older Men With and Without Pre-Existing Cardiovascular Disease 12 If one has already.... any cardiovascular disease; diabetes aged over 60 or with microalbuminuria; moderate or severe chronic kidney disease; familial hypercholesterolaemia; blood pressure over 180/110; or total cholesterol over 7.5mmol/litre - risk is high.
|
Search
Is there something else you would like to read about?This search button will bring up anywhere on this site your words are mentioned...
